Abstract:Objective To investigate the effectiveness of core decompression in combination with a nano-hydroxyapatite/polyamide 66 (n-HA/PA66) rod and a porous bioglass bone graft for the treatment of osteonecrosis of the femoral head (ONFH). Methods A prospectively designed algorithm was applied retrospectively to a cohort of sixty-four patients (84 hips) with ONFH, which were treated from 2009 to 2013 in the Department of Orthopaedics, the Second Affiliated Hospital of Xian Jiaotong University. These hips were allocated to a program of either core decompression core decomp-copy in combination with a n-HA/PA66 rod and a porous bio-glass bone graft (treatment group, 29 patients with 38 hips) or core decompression with an autologous cancellous bone graft (control group, 35 patients with 46 hips). Clinical and radiographic retrospective follow-ups were performed on all patients with the prospectively collected data. The HHS, VAS and survival-rate of implants were compared respectively. Results No significant difference was observed between two groups on HHS and VAS scores(all P values>0.05). HHS and VAS scores of treatment group were significantly improved than those of control group(all P values<0.01). HHS and VAS scores were increased significantly in both groups post-surgery (all P values<0.01). There was a significant difference between the two groups on HHS improvement for Steinberg ⅡB, ⅡC, and ⅢA (t=2.901, 2.242, 4.435, all P values<0.05) while other stages had no significant difference(all P values>0.05). Significant difference in the VAS improvement was observed between the groups for ⅡB, ⅡC and ⅢA (t=2.933, 2.119, 3.513, all P values<0.05) but did not detect in reminder stages(all P values>0.05). Further analysis of Kaplan-Meier curves found that implants survival of treatment group was higher than that of control group, which was proved significantly different by Log-rank test(χ2=6.753, P<0.05). Imaging failure rate of treatment group was 21.05%(8/38), which was lower than that of control group (45.65%, 21/46), while clinical failure of treatment group was also lower than that of control group [23.68%(9/38) vs 52.17%(24/46)], and both difference had statistical significance (χ2=5.571, 7.081, all P values< 0.05). Conclusions Core decompression combined with the implantation of a n-HA/PA66 rod and a bioglass bone graft can significantly decrease hip pain, improve hip function, and prevent the collapse of the femoral head in patients with ONFH. As the effectiveness of this approach appears to vary with Steinberg stage, we suggest that this treatment procedure may be suitable for patients with early to middle stage ONFH.
田润,李越,王坤正,党晓谦,杨佩. 髓芯减压联合纳米羟基磷灰石/聚酰胺66杆治疗股骨头坏死的前瞻性研究[J]. 中华解剖与临床杂志, 2017, 22(3): 201-207.
Tian Run, Li Yue, Wang Kunzheng, Dang Xiaoqian, Yang Pei. Core decompression combined with nano hydroxyapatite/polyamide 66 rod for the treatment of osteonecrosis of the femoral head. Chinese Journal of Anatomy and Clinics, 2017, 22(3): 201-207.
Helbig L, Simank HG, Kroeber M, et al.Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head[J].Arch Orthop Trauma Surg, 2012, 132(8): 1095-1103.DOI:10.1007/s00402-012-1526-3
[2]
Floerkemeier T, Lutz A, Nackenhorst U, et al.Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis[J].Int Orthop, 2011, 35(10): 1461-1466.DOI:10.1007/s00264-010-1138-x
[3]
Lieberman JR, Engstrom SM, Meneghini RM, et al.Which factors influence preservation of the osteonecrotic femoral head?[J].Clin Orthop Relat Res, 2012, 470(2): 525-534.DOI:10.1007/s11999-011-2050-4
[4]
Liu Y, Liu S, Su X.Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head[J].Arch Orthop Trauma Surg, 2012, 133(1): 125-133.DOI:10.1007/s00402-012-1623-3
[5]
Rajagopal M, Balch Samora J, Ellis TJ.Efficacy of core decompression as treatment for osteonecrosis of the hip: asystematic review[J].Hip Int, 2012, 22(5): 489-493.DOI:10.5301/HIP.2012.9748
[6]
Wang CJ, Huang CC, Wang JW, et al.Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight-to nine-year follow-up[J].Biomed J, 2012, 35(6): 481-485.DOI:10.4103/2319-4170.104413
[7]
Zhao D, Zhang Y, Wang W, et al.Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head[J].Orthopedics, 2013, 36(6): 789-795.DOI:10.3928/01477447-20130523-26
[8]
Tetik C, Basar H, Bezer M, et al.Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head[J].Acta Orthop Traumatol Turc, 2011, 45(5): 326-334.DOI: 10.3944/AOTT.2011.2259
Mont MA, Marulanda GA, Jones LC, et al.Systematic analysis of classification systems for osteonecrosis of the femoral head[J].J Bone Joint Surg Am, 2006, 88(Suppl 3): 16-26.DOI:10.2106/JBJS.F.00457
[11]
Wang BL, Sun W, Shi ZC, et al.Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window[J].Int Orthop, 2010, 34(5): 635-639.DOI:10.1007/s00264-009-0822-1
[12]
Franceschi F, Franceschetti E, Paciotti M, et al.Surgical management of osteonecrosis of the humeral head: a systematic reviewp[J].Knee Surg Sports Traumatol Arthrosc, 2016.doi: 10.1007/s00167-016-4169-z
[13]
Eward WC, Rineer CA, Urbaniak JR, et al.The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?[J].Clin Orthop Relat Res, 2012, 470(10): 2819-2826.DOI:10.1007/s11999-012-2429-x
[14]
Zhao G, Yamamoto T, Motomura G, et al.Radiological outcome analyses of transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head at a mean follow-up of 11 years[J].J Orthop Sci, 2013,18(2): 277-283.DOI:10.1007/s00776-012-0347-0
[15]
Mont MA, Jones LC, Pacheco I, et al.Radiographic predictors of outcome of core decompression for hips with osteonecrosis stage Ⅲ[J].Clin Orthop Relat Res, 1998(354): 159-168.DOI:10.1097/00003086-199809000-00019
[16]
Fairbank AC, Bhatia D, Jinnah RH, et al.Long-term results of core decompression for ischaemic necrosis of the femoral head[J].J Bone Joint Surg Br, 1995,77(1):42-49
[17]
Powell ET, Lanzer WL, Mankey MG.Core decompression for early osteonecrosis of the hip in high risk patients[J].Clin Orthop Relat Res, 1997(335): 181-189
[18]
Marker DR, Seyler TM, Ulrich SD, et al.Do modern techniques improve core decompression outcomes for hip osteonecrosis?[J].Clin Orthop Relat Res, 2008, 466(5): 1093-1103.DOI:10.1007/s11999-008-0184-9
[19]
Hernigou P, Habibi A, Bachir D, et al.The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease[J].J Bone Joint Surg Am, 2006, 88(12): 2565-2572.DOI:10.2106/JBJS.E.01455
[20]
Ha YC, Jung WH, Kim JR, et al.Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images[J].J Bone Joint Surg Am, 2006, 88(Suppl 3): 35-40.DOI:10.2106/JBJS.F.00535
[21]
Petrigliano FA, Lieberman JR.Osteonecrosis of the hip: novel approaches to evaluation and treatment[J].Clin Orthop Relat Res, 2007, 465: 53-62.DOI:10.1097/BLO.0b013e3181591c92
[22]
Israelite C, Nelson CL, Ziarani CF, et al.Bilateral core decompression for osteonecrosis of the femoral head[J].Clin Orthop Relat Res, 2005, 441: 285-290.DOI:10.1097/01.blo.0000192365.58958.84
[23]
Zeimaran E, Pourshahrestani S, Djordjevic I, et al.Bioactive glass reinforced elastomer composites for skeletal regeneration: a review[J].Mater Sci Eng C Mater Biol Appl, 2015,53: 175-188.DOI: 10.1016/j.msec.2015.04.035
Yang X, Song Y, Liu L, et al.Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy[J].Orthopedics, 2012, 35(1): e66-e73.DOI:10.3928/01477447-20111122-10
[26]
Qian X, Yuan F, Zhimin Z, et al.Dynamic perfusion bioreactor system for 3D culture of rat bone marrow mesenchymal stem cells on nanohydroxyapatite/polyamide 66 scaffold in vitro[J].J Biomed Mater Res Part B Appl Biomater, 2013, 101(6): 893-901.DOI:10.1002/jbm.b.32894